An overview of systematic reviews on upper extremity outcome measures after stroke.

Alt Murphy M, Resteghini C, Feys P, Lamers I - BMC Neurol (2015)

Bottom Line:
As the aims, objectives and methodology of the existing reviews of the upper extremity outcome measures can vary, there is a need to bring together the evidence from existing multiple reviews.The strongest level of measurement quality and clinical utility was demonstrated for Fugl-Meyer Assessment, Action Research Arm Test, Box and Block Test, Chedoke Arm and Hand Activity Inventory, Wolf Motor Function Test and ABILHAND.This overview can provide a valuable resource to assist clinicians, researchers and policy makers in selection of appropriate outcome measures.

Background: Although use of standardized and scientifically sound outcome measures is highly encouraged in clinical practice and research, there is still no clear recommendation on which tools should be preferred for upper extremity assessment after stroke. As the aims, objectives and methodology of the existing reviews of the upper extremity outcome measures can vary, there is a need to bring together the evidence from existing multiple reviews. The purpose of this review was to provide an overview of evidence of the psychometric properties and clinical utility of upper extremity outcome measures for use in stroke, by systematically evaluating and summarizing findings from systematic reviews.

Methods: A comprehensive systematic search was performed including systematic reviews from 2004 to February 2014. A methodological quality appraisal of the reviews was performed using the AMSTAR-tool.

Results: From 13 included systematic reviews, 53 measures were identified of which 13 met the standardized criteria set for the psychometric properties. The strongest level of measurement quality and clinical utility was demonstrated for Fugl-Meyer Assessment, Action Research Arm Test, Box and Block Test, Chedoke Arm and Hand Activity Inventory, Wolf Motor Function Test and ABILHAND.

Conclusions: This overview of systematic reviews provides a comprehensive systematic synthesis of evidence on which outcome measures demonstrate a high level of measurement quality and clinical utility and which can be considered as most suitable for upper extremity assessment after stroke. This overview can provide a valuable resource to assist clinicians, researchers and policy makers in selection of appropriate outcome measures.

Fig3: Publication years for the primary references used in the systematic reviews and years when the reviews were performed, presented separately for every outcome measure included into the final set of measures.

Mentions:
Figure 3 provides an overview of the publication years of the primary references used in the systematic reviews. Figure 4 illustrates the overlap of the primary articles included in the reviews, which was in average 19%. Accordingly, for nine OM none or only one primary source was used in more than one review, for BBT and ABILHAND 2 out of 6 primary articles were used in more than one review and for FMA 4 of 22 and for ARAT 7 of 19 references were used in more than one review.Figure 3

Fig3: Publication years for the primary references used in the systematic reviews and years when the reviews were performed, presented separately for every outcome measure included into the final set of measures.

Mentions:
Figure 3 provides an overview of the publication years of the primary references used in the systematic reviews. Figure 4 illustrates the overlap of the primary articles included in the reviews, which was in average 19%. Accordingly, for nine OM none or only one primary source was used in more than one review, for BBT and ABILHAND 2 out of 6 primary articles were used in more than one review and for FMA 4 of 22 and for ARAT 7 of 19 references were used in more than one review.Figure 3

Bottom Line:
As the aims, objectives and methodology of the existing reviews of the upper extremity outcome measures can vary, there is a need to bring together the evidence from existing multiple reviews.The strongest level of measurement quality and clinical utility was demonstrated for Fugl-Meyer Assessment, Action Research Arm Test, Box and Block Test, Chedoke Arm and Hand Activity Inventory, Wolf Motor Function Test and ABILHAND.This overview can provide a valuable resource to assist clinicians, researchers and policy makers in selection of appropriate outcome measures.

Background: Although use of standardized and scientifically sound outcome measures is highly encouraged in clinical practice and research, there is still no clear recommendation on which tools should be preferred for upper extremity assessment after stroke. As the aims, objectives and methodology of the existing reviews of the upper extremity outcome measures can vary, there is a need to bring together the evidence from existing multiple reviews. The purpose of this review was to provide an overview of evidence of the psychometric properties and clinical utility of upper extremity outcome measures for use in stroke, by systematically evaluating and summarizing findings from systematic reviews.

Methods: A comprehensive systematic search was performed including systematic reviews from 2004 to February 2014. A methodological quality appraisal of the reviews was performed using the AMSTAR-tool.

Results: From 13 included systematic reviews, 53 measures were identified of which 13 met the standardized criteria set for the psychometric properties. The strongest level of measurement quality and clinical utility was demonstrated for Fugl-Meyer Assessment, Action Research Arm Test, Box and Block Test, Chedoke Arm and Hand Activity Inventory, Wolf Motor Function Test and ABILHAND.

Conclusions: This overview of systematic reviews provides a comprehensive systematic synthesis of evidence on which outcome measures demonstrate a high level of measurement quality and clinical utility and which can be considered as most suitable for upper extremity assessment after stroke. This overview can provide a valuable resource to assist clinicians, researchers and policy makers in selection of appropriate outcome measures.